The relevance of complying with OSHA's guideline safety controls for home healthcare workers has recently taken on greater significance due to proposals filed in Congress which call on the Secretary of Labor to issue an enforceable safety and health standard similar to OSHA's guidance.
At the end of last year, Connecticut Rep. Joe Courtney introduced a Congressional bill entitled the “Workplace Violence Prevention for Health Care and Social Workers Act” (PDF). The bill, if passed, will direct the Secretary of Labor to issue an enforceable safety and health standard similar to OSHA's “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” (PDF).
Although a number of states have implemented workplace violence prevention programs for healthcare facilities, many of the programs are location-specific inasmuch as they only address threats in certain areas such as Emergency Rooms or Psychiatric Units. What is significant about OSHA's Guidelines is that they take into account the risks faced on a daily basis by home healthcare workers.
The Risks Faced by Home Healthcare Workers
The risks faced by home healthcare workers are exactly the same as those faced by on-premises healthcare workers - typically violence, verbal aggression, and sexual assault. The difference between the venues is that when a home healthcare worker is attacked, the event occurs when they are working alone and isolated from the safety controls one would find in a healthcare facility.
Unfortunately, it is impossible to quantify how many home healthcare workers are the victims of violence, verbal aggression, and sexual assault due to significant underreporting. However, one survey reported healthcare workers working in the community were twice as likely to experience violence or aggression at work as on-premises healthcare workers.
Administrative Safety Controls for Home Healthcare Workers
OSHA's administrative safety controls for home healthcare workers appears under the “Administrative and Work Practice Controls” of the guidance. The safety controls divide responsibility for safety between nursing managers and home healthcare workers inasmuch as nursing managers are responsible for providing relevant training and developing safety procedures, while workers have a duty to report all assaults, attempted assaults, or threats of assaults, and maintain logbooks of such incidents.
In addition, home healthcare workers should have specific log-in and log-out procedures that require them to contact their nursing manager's office before and after each patient visit. The log-in/log-out procedures should include:
- The name and address of the patient being visited.
- The expected duration of the visit.
- A code word to use in the event of an incident.
- Details of any travel plans with the patient.
The home healthcare worker must contact the office if the plans change or the visit overruns, while office personnel must have procedures to follow if a worker fails to log in as expected.
Physical Safety Controls for Home Healthcare Workers
When working in an environment where there is a high risk of an assault, OSHA recommends implementing a “buddy system”, or giving workers the discretion to receive back-up assistance from another worker or a law enforcement office. In every event, OSHA's guidelines state workers have an effective means of communication, and suggests a cell phone or panic button.
Although OSHA is technology neutral when it comes to suggesting what type of personal safety or panic button system is implemented, it makes sense to use a smartphone app rather than a wearable device that connects via Bluetooth to a smartphone - the reason being that, with a wearable device that connects to a smartphone, personnel have to keep two devices charged instead of one. There is also more likelihood of a wearable device being forgotten and some Bluetooth-enabled panic buttons have been found to have security flaws which may make them unreliable safety controls in an emergency.
A Smartphone Personal Safety App for Home Healthcare Workers
By comparison, one personal safety mobile app provides location-based alerting to security or 9-1-1 with a tap of a smartphone screen. Nursing managers are simultaneously alerted to an attack to facilitate a coordinated response, and the event is automatically logged on a management console. Employees can be provided with a virtual escort every time they travel.